Provider Demographics
NPI:1215014568
Name:WILCOX, REBECCA A (SLP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:WILCOX
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 WHISPERING PINE RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-5456
Mailing Address - Country:US
Mailing Address - Phone:501-416-4674
Mailing Address - Fax:
Practice Address - Street 1:2600 WHISPERING PINE RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72210-5456
Practice Address - Country:US
Practice Address - Phone:501-416-4674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP556235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5S463OtherBLUE CROSS BLUE SHIELD